Chronic Shoulder Disorders

Dr Mustafa Elsingergy

Consultant Orthopedic Surgeon

Shoulder Pain

INTRINSIC DUE TO CAUSES IN THE SHOULDER REGION

EXTRINSIC DUE TO REFERRED PAIN FROM OUTSIDE THE SHOULDER

Shoulder Pain

INTRINSIC DUE TO CAUSES IN THE SHOULDER REGION

EXTRINSIC DUE TO REFERRED PAIN FROM OUTSIDE THE SHOULDER

Shoulder Pain

INTRINSIC DUE TO CAUSES IN THE SHOULDER REGION

EXTRINSIC DUE TO REFERRED PAIN FROM OUTSIDE THE SHOULDER

SHOULDER DISORDERS

DUE TO CAUSES RELATED TO :

1. ROTATOR CUFF (RC)

2. SHOULDER CAPSULE

3. GLENOHUMERAL JOINT (GLJ)

4. SCAPULAR PROBLEMS

5. ACROMIOCLAVICULAR JOINT (ACJ)

ROTATOR CUFF ANATOMY :

ORGINATE FROM THE SCAPULA

INSERT IN THE GT AND LT

PASS UNDER CORACOACROMIAL ARCH

SEPARATE FROM THE LIGAMENT BY BURSA

ROTATOR CUFF DISORDERS(R.C.D)

ACUTE TENDENITIS IMPINGEMENT SYNDROME ROTATOR CUFF TEAR

R.C.DACUTE TENDINITIS

CLINICAL FEATURES

PAIN

TENDERNESS

PAINFUL ABDUCTION RANGE

X-RAY

NORMAL

AREA OF CALCIFICATION

TREATMENT

REST

NSAID

LOCAL INJECTION

R.C.DIMPINGEMENT SYNDROME

CAUSES

CLINICAL FEATURES

• PAIN

• SHOULDER LOOKS NORMAL OR WASTED

• TENDERNESS

• DISTURBED GLENOHUMERAL RHYTHM

• PAINFUL ABDUCTION ( 6O TO 120 )

• NEER’S TEST (+VE)

• HAWKIN’S TEST (+VE)

R.C.DIMPINGEMENT SYNDROME

XRAY

• CALCIFICATION

• DEGENERATED ACJ

MRI

• BURSITIS

• THICKENING OF THE TENDON

TREATMENT

• MILD: NSAID, LOCAL INJECTION

• SEVERE: ARTHROSCOPY VS ACRMOIOPLASTY

R.C.DROTATOR CUFF TEAR

CAUSES

• PREDISPOSING FACTOR

• DEGENERATION: MIDDLE AGE

• CHRONIC IRRITATION BY OSTEOPHYTE

• UNDERLYING DISEASE ex. RHEUMATOID

• PRECEPATATING FACTOR TRAUMA

TYPES: INCOMPLETE

COMPLETE

R.C.DROTATOR CUFF TEAR

CLINICAL FEATURES

• TRAUMA, PAIN, LIMITED ABDUCTIOIN

• AFTER FEW WEEKS:

INCOMPLETE TEAR: IMPROVEMENT OF PAIN AND ROM

COMPLETE TEAR: IMPROVEMENT OF PAIN AND DECREASE OF ACTIVE RANGE

o LOOK:

EARLY; NORMAL APPEARENCE

LATE; WASTING OF SUPRASPINATUS AND INFRASPINATUS MUSCLES

o FEEL

TENDER GREATER TUBEROSITY

R.C.DROTATOR CUFF TEAR

CLINICAL FEATURE:

o MOVE: INCOMPLETE TEAR; PAINFUL WEAK

COMPLETE; PASSIVE NOT PAINFUL, ACTIVE DROP ARM SIGN

XRAYS: EARLY NORMAL

LATE DEGENERATIVE CHANGES

MRI IMAGE OF CHOICE

TREAMENT: INCOMPLETE TEAR: PT, NSA ID

COMPLETE TEAR: SURGERY

BICEPS TENDON DISORDERS

TENDENITES

PAIN

TENDERNECE: BICEPITAL GROOVE

PIANFUL FORWAD FLEXTION

TREAMENT: NSAID, LOCAL INJECTION

TEAR OF LONG HEAD OF BICEPS TENDON

PAIN

DEFORMITY OF BICEPS CONTOUR ( POPEYE’S ARM)

NO NEED FOR TREAMENT

ADHESIVE CAPSULITIS(FROZEN SHOULDER)

UNKNOWN PATHOGENESIS LEADS TO PAIN AND LIMITATION OF MOVEMENT

TRAUMA OR RCD MAY BE CAUSES

CLINICAL FEATURE

PAIN

LIMITATION OF MOVEMENT IN ALL DIRECTIONS OF G-H RANGE

NATURAL HISTORY

PAIN AND LIMITATION OF MOVEMENT GRADUALLY INCREASE THEN GRADUALLY DECREASE, TAKES 18 MONTHS

TREATMENT

CONSERVATIVE VS ARHTROSCOPY

RECURRENT SHOULDER INSTABILITY

TYPES

RECURRENT ANTERIOR DISLOCATION (RAD)

RECURENT POSTERIOR SUBLUXATION(rare)

MULTIDIRECTIONAL INSTABILITY (MDI)

RAD MDI

TRAUMATIC ATRAUMATIC

APREHENSIVE TEST SULCUS SIGN POSITIVE

SURGICAL TREAMENT PT

RECURRENT SHOULDER INSTABILITY

MULTIDIRECTIONAL INSTABILITY :GENERALISED LIGAMENTOUS LAXITY

SALUCUS SIGN (+VE)

RECURRENT SHOULDER INSTABILITY

RECURRENT ANTERIOR DISLOCATION (RAD): MOST COMMON

H/O ACUTE DISLOCATION

APPREHENSION TEST (+VE)

IMAGE:

HILL SACHUS LESION

BANKART LESION

RECURRENT SHOULDER INSTABILITY

RECURRENT ANTERIOR DISLOCATION (RAD)

MULTIDIRECTIONAL INSTABILITY (MDI)

RAD MDI

TRAUMATIC ATRAUMATIC

APREHENSIVE TEST SULCUS SIGN POSITIVE

SURGICAL TREAMENT PT

GLENOHUMERAL JOINT DISORDER

TB

RHEUMATOID

OSTEOARHTERITIS

MIL WAUKEE

GLENOHUMERAL RHEUMATOID ARTHERITIS

CLINICAL FEATURE

GENERALIZED ARTHERITIS AFFECTING OTHER JOINTS

PIAN AND LIMITATION OF MOVEMENT

PAINFUL PASSIVE MOVEMENT AND LIMITED ACTIVE MOVEMENT

LAB INVESTIGATION: +VE RHEUMATOID FACTOR

XRAY:

LOSS OF ARTICULAR SPACE

PREARTICULAR EROSION

GLENOHUMERAL OSTEOARTHERITIS

USUALLY FOLLOW OTHER PATHOLOGY eg. TRAUMA, RHEUMATOID ARTHERITIS OR RC TEARS

CLINICAL FEATURE

PAINFUL MOVEMENT

WASTING THE SHOULDER MUSCLE

TENDER JOINT LINE

LIMITED ROM

XRAY

LOSS OF JOINT SPACE

SUBCONDIRAL SCHLEROSIS

TREAMENT

ACROMIOCLAVICULAR DISORDERS

INSTABBILITY

ARTHERITIS

SCAPULAR DISORDERS

SPRENGEL SHOULDER:

CONGGENITAL

WINGING OF SCAPULA:

WEAK SERRATU ANT MUSCLE

Shoulder SUMMARY

Shoulder SymptomsPainStiffnessInstabilityDeformityLoss of Function

Shoulder EXAMINATIONSLookFeelMoveSpecial Tests

InvestigationLabImages

Treatment Conservative surgical

THANK YOU